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Pharm I: Exam 2 > RA > Flashcards

RA Flashcards

1
Q

What is Rheumatoid Arthritis (RA)?

A

Chronic, systemic inflammatory disease of the joints and related structures

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2
Q

What is the pathophysiology related to RA?

A
  • Immune-mediated inflammatory process
  • Attacks synovium and other vital organs/tissues
  • Erosive, symmetric joint involvement (frequently hands and feet)
  • Chronic inflammation of synovial lining ( tissue exceeds borders and erodes into bone and cartilage within joint capsule pannus
  • End result: joint destruction and deformity
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3
Q

What are key clinical features of RA?

A
  • Morning stiffness that subsides after at least 30 minutes
  • Stiff, painful, tender and/or swollen joints (“boggy” and warm to palpate)
  • Progressively symmetrical presentation (Polyarticular)
  • Hand/Foot deformities (e.g. Swan-neck, Boutonniere, ulnar deviation, ‘hammer’ toe)
  • Constitutional S/Sx
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4
Q

What is the primary objective and goal of therapy for RA?

A
  • Objective: To improve/maintain functional status and improve QOL
  • TX Goal: To relieve pain, preserve joint function and prevent/control joint destruction and systemic complications
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5
Q

What are non-drug therapy options for RA?

A
  • Rest
  • PT/OT
  • Assistive devices
  • Weight reduction/management
  • Splinting/join protection
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6
Q

What are DMARDs?

A

(disease modifying anti-rheumatic drugs) a group of drugs that have potential to prevent joint damage

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7
Q

What is the MOST common monotherapy for RA?

A

Methotrexate (MTX); other may also be used

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8
Q

What are the most common Double DMARD therapy?

A

Any double combination of MTX, SSZ, HCQ, LEF

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9
Q

What is utilized in triple DMARD therapy?

A

MTX + SSZ + HCQ

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10
Q

What medications are classified as Non-biologic DMARDs? (4)

A
  • ​​Hydroxychloroquine (HCQ)
  • Methotrexate (MTX)
  • Sulfasalazine (SSZ)
  • Leflunomide (LEF)
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11
Q

How does Hydroxychloroquine (HCQ) function?

A

Antimalarial; slows progression of erosive bone lesions (may induce remission); relatively fast onset (2-6 months; D/C if no response >6 months)

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12
Q

What are therapeutic uses for Hydroxychloroquine (HCQ)?

A
  • Mild RA
  • Combination (Double/Triple DMARD therapy)
  • Reserved for RA unresponsive to NSAIDs
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13
Q

What should be monitored when utilizing Hydroxychloroquine (HCQ)?

A

Minimal

  • Ophthalmologic exam bi-annually (retinal toxicity)
  • Does not cause liver/kidney/ bone toxicities
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14
Q

What are ADRs associated with Hydroxychloroquine (HCQ)?

A
  • GI: N/V/D (take with food)
  • Derm: pruritus, rash, alopecia, INC skin pigmentation
  • Neuro: HA, insomnia, vertigo
  • Ocular Toxicity
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15
Q

How does Methotrexate (MTX) function?

A

Acts as immunosuppressive and anti-inflammatory agent (folic acid antagonist); slows appearance of new erosions

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16
Q

What are therapeutic uses for Methotrexate (MTX)?

A
  • 1st LINE monotherapy DMARD
  • MAINSTAY moderate to severe RA (patients not responding to NSAIDs adequately)
    *
17
Q

What are ADRs for Methotrexate (MTX)?

A
  • GI: N/V/D, stomatitis (dose-related)
  • Hematologic: thrombocytopenia, leukopenia
  • Pulmonary: fibrosis, pneumonitis
  • Hepatic: ELEVATED liver enzymes, cirrhosis
18
Q

What is a drug interaction with Methotrexate (MTX)?

A
  • NSAIDs (may DEC Clearance, INC ADRs)
19
Q

What should be monitored when utilizing Methotrexate (MTX)?

A
  • Baseline: LFTs, CBC, Total bilirubin, HBV and HCV studies, serum Creatinine, albumin
  • Q1-2 months: CBC, AST, albumin
20
Q

How does Sulfasalazine (SSZ) function?

A

PRODRUG cleaved in the colon to sulfapyridine (anti-rheumatic properties)

21
Q

What are the therapeutic uses for Sulfasalazine (SSZ)?

A
  • Mild RA
  • Combination (Double/Triple)
22
Q

What should be monitored when utilizing Sulfasalazine (SSZ)?

A
  • Baseline: CBC
  • Month 1: CBC Q week
  • Continuing: CBC Q 1-2 months
23
Q

How does Leflunomide (LEF) function?

A
  • Interferes with RNA/DNA synthesis in lymphocytes (reversible inhibitor of DHODH)
  • Reduces pain and inflammation associated with RA (slows progression of structural damage)
24
Q

What are ADRs associated with Leflunomide (LEF)?

A
  • N/V
  • HA
  • Rash
  • Alopecia
  • Liver toxicity (CAUTION with Liver disease)
  • Pregnancy Category X (Wash cholestyramine out prior to conception)
25
Q

What medications are classified as Tumor Necrosis Factor (TNF) Antagonist? (3)

A

(Biologic DMARDs)

  • Etanercept
  • Infliximab
  • Adalimumab
26
Q

How does Entanercept function?

A

Soluble TNF receptor that competitively binds 2 TNF molecules (renders inactive)

27
Q

How do Infliximab and Adalimumab function?

A

Anti-TNF alpha monoclonal antibody (IgG) that inhibit progression of structural damage

28
Q

What should be monitored when utilizing Anti-TNF agents?

A
  • Initial tuberculin skin test
  • Additive effects when in combination with Methotrexate (MTX)
    • Infliximab only: Human anti-chimeric molecule Ab development
29
Q

What ADRs are associated with Infliximab?

A

Infusion-related HA/Nausea

30
Q

What ADRs are associated with Etanercept and Adalimumab?

A

Injection site reactions

31
Q

What medications are classified as Interleukin-1 receptor Antagonist? (1)

A

Anakinra (TX moderate to severe RA)

32
Q

How does Anakinra function?

A
  • Slows degradation of cartilage and bone resorption
  • TX options: Monotherapy or Combo w/ MTX
33
Q

What are ADRs associated with Anakinra?

A
  • Similiar to Anti-TNF agents
  • Injection site reactions
  • DO NOT USE combo with Anti-TNF (reserve for after Anti-TNF therapy is unsuccessful
34
Q

What medications are classified as Non-TNF agents? (3)

A

(Biologic DMARD)

  • Abatacept
  • Rituximab
  • Tofacitinib
35
Q

How does Abatacept function?

A
  • Inhibits T-lymphocyte activation (soluble fusion protein)
  • TX options: monotherapy or combo
  • VERY EXPENSIVE
36
Q

How does Rituximab function?

A
  • Depletes B lymphocytes (reduces Ab formation)
  • Combo with MTX for moderate to severe cases with inadequate response to ANTI-TNF agents (FDA)
37
Q

How does Tofacitinib function?

A
  • Inhibits Jaus kinase (JAK) enzymes (intracellular enzymes involved in stimulation of hematopoiesis and immune cell function)
  • BLACK BOX WARNING (infections and malignancy)
  • TX Option: monotherapy or combo W/ MTX or non-biologics (TX Moderate to severe RA)
38
Q

Why are corticosteroids useful in RA treatment?

A

Could be used as a bridge to control debilitating symptoms until DMARDs take effect

39
Q

What medications may alleviate ADRs associated with Methotrexate?

A
  • Folic Acid (may alleviate ADRs)
  • Leucovorin (folic acid derivative, antidote to MTX toxicity)

Pharm I: Exam 2 (7 decks)

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